The epidemic of heart failure has stimulated interest in understanding cardiac regeneration. Evidence has been reported supporting regeneration via transplantation of multiple cell types, as well as replication of postmitotic cardiomyocytes. In addition, the adult myocardium harbors endogenous c-kit(pos) cardiac stem cells (eCSCs), whose relevance for regeneration is controversial. Here, using different rodent models of diffuse myocardial damage causing acute heart failure, we show that eCSCs restore cardiac function by regenerating lost cardiomyocytes. Ablation of the eCSC abolishes regeneration and functional recovery. The regenerative process is completely restored by replacing the ablated eCSCs with the progeny of one eCSC. eCSCs recovered from the host and recloned retain their regenerative potential in vivo and in vitro. After regeneration, selective suicide of these exogenous CSCs and their progeny abolishes regeneration, severely impairing ventricular performance. These data show that c-kit(pos) eCSCs are necessary and sufficient for the regeneration and repair of myocardial damage.

Key Words: vascular smooth muscle cells Ⅲ microRNA Ⅲ miR-133 Ⅲ smooth muscle differentiation Ⅲ vascular remodeling V ascular smooth muscle cells (VSMCs) within adult blood vessels proliferate at a very low rate, exhibit very low synthetic activity, and express a unique repertoire of contractile proteins, ion channels, and signaling molecules. 1 Unlike skeletal muscle and cardiac muscle, which consist of terminally differentiated cells, adult VSMCs retain remarkable plasticity and can undergo rather profound and reversible changes in phenotype and growth properties in response to changes in local environmental cues. Salient examples of VSMC plasticity can be seen in response to vascular injury when VSMCs dramatically increase their proliferation, migration, and synthetic capacity, playing a critical role in vascular repair. 1,2 A detrimental consequence of the high degree of plasticity exhibited by adult VSMCs is that it can lead to an adverse phenotypic switch and acquisition of characteristics that can contribute to development or progression of vascular disease in humans, including atherosclerosis, restenosis, cancer, and hypertension. [1][2][3] VSMC phenotypic modulation is characterized by significant changes in gene expression patterns, matrix and cytokine production, contractility, and growth state, ultimately leading to their switch from a synthetic to a proliferative phenotype.Original received January 3, 2011; revision received August 8, 2011; accepted August 9, 2011. In July 2011, the average time from submission to first decision for all original research papers submitted to Circulation Research was 13.5 days.From Thus, understanding the regulatory mechanisms underlying the VSMC phenotypic switch is of paramount importance. [1][2][3] One of the key breakthroughs for the study of gene expression regulation has recently been the discovery of microRNAs (miRNAs or miRs) and their role in gene silencing through mRNA degradation or translational inhibition. 4,5 Increasing evidence indicates that miRNAs regulate key genetic programs in cardiovascular biology, physiology, and disease. 4,5 In particular, miR-21, -143, -145, -221, -222 have all been implicated to play a role in VSMC function and phenotypic plasticity. 6 -11 More recently, 2 articles demonstrated that miR-1 is induced by myocardin overexpression in human SMCs, contributing to myocardin-dependent reduction of human SMC growth in vitro. 12,13 miR-133a-1/miR-1-2 and miR133a-2/miR-1-1 are 2 bicistronic miRNA clusters reported to be specifically expressed in cardiac and skeletal muscle. 4,5 A third bicistronic miRNA cluster, comprising miR-206 and miR-133b, is expressed specifically in skeletal muscle but not in the heart. 4,5 miR-1 (miR-1-1/miR-1-2) and miR-133 (miR133a-1/miR-133a-2) play essential roles in cardiac and skeletal muscle development, physiology, and disease 4,5 ; however, their functions in VSMCs and vascular disease are largely unknown. Thus, the aim of the present study was to evaluate the role, if any, of miR-1 and miR-133 in V...

Multipotent adult resident cardiac stem cells (CSCs) were first identified by the expression of c-kit, the stem cell factor receptor. However, in the adult myocardium c-kit alone cannot distinguish CSCs from other c-kit-expressing (c-kitpos) cells. The adult heart indeed contains a heterogeneous mixture of c-kitpos cells, mainly composed of mast and endothelial/progenitor cells. This heterogeneity of cardiac c-kitpos cells has generated confusion and controversy about the existence and role of CSCs in the adult heart. Here, to unravel CSC identity within the heterogeneous c-kit-expressing cardiac cell population, c-kitpos cardiac cells were separated through CD45-positive or -negative sorting followed by c-kitpos sorting. The blood/endothelial lineage-committed (Lineagepos) CD45posc-kitpos cardiac cells were compared to CD45neg(Lineageneg/Linneg) c-kitpos cardiac cells for stemness and myogenic properties in vitro and in vivo. The majority (~90%) of the resident c-kitpos cardiac cells are blood/endothelial lineage-committed CD45posCD31posc-kitpos cells. In contrast, the LinnegCD45negc-kitpos cardiac cell cohort, which represents ⩽10% of the total c-kitpos cells, contain all the cardiac cells with the properties of adult multipotent CSCs. These characteristics are absent from the c-kitneg and the blood/endothelial lineage-committed c-kitpos cardiac cells. Single Linnegc-kitpos cell-derived clones, which represent only 1–2% of total c-kitpos myocardial cells, when stimulated with TGF-β/Wnt molecules, acquire full transcriptome and protein expression, sarcomere organisation, spontaneous contraction and electrophysiological properties of differentiated cardiomyocytes (CMs). Genetically tagged cloned progeny of one Linnegc-kitpos cell when injected into the infarcted myocardium, results in significant regeneration of new CMs, arterioles and capillaries, derived from the injected cells. The CSC’s myogenic regenerative capacity is dependent on commitment to the CM lineage through activation of the SMAD2 pathway. Such regeneration was not apparent when blood/endothelial lineage-committed c-kitpos cardiac cells were injected. Thus, among the cardiac c-kitpos cell cohort only a very small fraction has the phenotype and the differentiation/regenerative potential characteristics of true multipotent CSCs.

In an animal model of AMI relevant to the human disease, intracoronary administration of IGF-1/HGF is a practical and effective strategy to reduce pathological cardiac remodeling, induce myocardial regeneration, and improve ventricular function.